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RePub, Erasmus University RepositoryHost-pathogen interaction during pneumococcal infection in patients with chronic obstructive pulmonary diseasehttp://repub.eur.nl/pub/10303/
Thu, 01 Jan 2004 00:00:01 GMT<div>D. Bogaert</div><div>P. van der Valk</div><div>R. Ramdin</div><div>M. Sluijter</div><div>E. Monninkhof</div><div>R. Hendrix</div><div>R. de Groot</div><div>P.W.M. Hermans</div>
Acute exacerbation is a frequent complication of chronic obstructive
pulmonary disease (COPD). Recent studies suggested a role for bacteria
such as Streptococcus pneumoniae in the development of acute exacerbation.
For this study, we investigated the following in COPD patients: (i) the
epidemiology of pneumococcal colonization and infection, (ii) the effect
of pneumococcal colonization on the development of exacerbation, and (iii)
the immunological response against S. pneumoniae. We cultured sputa of 269
COPD patients during a stable state and during exacerbation of COPD and
characterized 115 pneumococcal isolates by use of serotyping. Moreover, we
studied serum immunoglobulin G (IgG) antibody titers, antibody avidities,
and functional antibody titers against the seven conjugate vaccine
serotypes in these patients. Colonization with only pneumococci
(monocultures) increased the risk of exacerbation, with a hazard ratio of
2.93 (95% confidence interval, 1.41 to 6.07). The most prevalent
pneumococcal serotypes found were serotypes 19F, 3, 14, 9L/N/V, 23A/B, and
11. We calculated the theoretical coverage for the 7- and 11-valent
pneumococcal vaccines to be 60 and 73%, respectively. All patients had
detectable IgG levels against the seven conjugate vaccine serotypes. These
antibody titers were significantly lower than those in vaccinated healthy
adults. Finally, on average, a 2.5-fold rise in serotype-specific and
functional antibodies in S. pneumoniae-positive sputum cultures was
observed during exacerbation. Our data indicate that pneumococcal
colonization in COPD patients is frequently caused by vaccine serotype
strains. Moreover, pneumococcal colonization is a risk factor for
exacerbation of COPD. Finally, our findings demonstrate that COPD patients
are able to mount a significant immune response to pneumococcal infection.
COPD patients may therefore benefit from pneumococcal vaccination.